1999, 10-14 Permit App: 99009838 Sewer' Spokane County Division of Utilities
SEWER CONNECTION PERMIT q�j I _ i
APPLICATION FORM
•
PLEASE NOTE: This application form must be filled out accurately and in its entirety, and signed, or a permit will not be issue
Also note that sewer permits are valid for 12 months from the date of issuance. No extensions will be granted.
PROJECT INFORMATION
Job address:, - ..-
// E ('ra. c e_
Q
Dry Line -
Sewer? (Y/N)
Owner's'snams ,
,(l/GfC 6, /se nh 1/7 9
City:,3.6 /'b
City/State. )l,, /
Zip: Q 4 .2Oa
��li
Zip: 94 2 e2 �i -
Parcel number tirkawnl:� j2
Phone: 92 7.- /3) 3
First-time contractors or home -owners performing the installation
before a permit can be issued.
Name of Utilities Division person contacted:
• CONTRACTOR
must first contact
the utilities department (7n person)
INFORMATION
Contractor (company name):
CC, 1
State contractor license number:
CEN IL -L 123 NF
Business address:
L.L0—$7. /LutoL N CdST20c7"tt� . I N c. .0023
Contact Name: /
Sl�l ULA 1
City/State: Po Bo7' - /,, 7'/ l4'I PL .lP
Phone: q2.- I I6`T 9
Zip: F,SSC25" Phone:
INTERIOR PLUMBING ALTERATIONS? (.es no) circle me
' Fill out the information in the table below if applicable"
Contractor (if different from above):
'Phone:
Business Address: City/State/Zip:-
............
.. ... , ?s#.'FOr ttyptblitgl'ev seetwe estateD rhes [tA:i j::•......r._""':"° `
Sewer Connection: Number of Buildings.
• For a single-family residential unit,
• For a condominium, townhouse,
address and separate stub, one permit
• For a single building dupies, triplex
• Multiple buildings (apartments, industrial
the sewer.
(For situations
APPLICANT SIGNATURE: iyie
FEE Idi
) xOim * poo = $ /00
•NFORMATION
TOTAL FEE
one permit is required.
duplex, triples or fourplcc with separate ownership (as determined by lot lines) se1,-
is required per address per stub;
or fourplcc with single ownership, one permit is required
complexes) with single ownership, one permit required per building connect$
not covered here, call the County Division of Utilities @ 456-3604)
Ca nn I %� Date:
es b... (s.bJ,9m es.
.
PHONE (509)
'Jinn a ae•me, or •RMer a in pima O =TIDO
, . Spokane Cm, Diaenen of Bailing /
Wert 1026 Brom", AVOWS • Spokane, WVatbing n
456.3675, • FAX (509) 324-3198 • TDD: (509) 2
Spot•,. Caron does no, dizattnama
d.
e
g to
to:
laming
99260
X3166